Fecal incontinence (FI) is defined as the involuntary loss of solid or liquid stool and has an enormous impact on quality of life. Continence depends on a number of factors including cognitive function, stool volume and stool consistency, colonic transit, rectal compliance, anal sphincter function, anorectal sensation, and anorectal reflexes. Loss of continence often results from impairment in any of these factors. Initial evaluation consists of a focused history and a physical examination looking for potential reversible and/or treatable factors. First-line treatment include dietary, behavioral, and pharmacologic management approaches in community-dwelling and long-term care settings. If first-line treatments are not effective, additional evaluation with anorectal manometry and other tests may be warranted. Surgical treatments for FI may improve symptoms and more efficacy data is needed, especially among older adults. Therapeutic options using behavioral, pharmacological, and surgical approaches can lead to symptomatic improvements or cure for FI and increased quality of life for the older patient.